MassHealth for Long-Term Care in MA

If you are over 65 years of age or have a loved one who is, you may be considering a future that includes long-term care. And you’re not alone: the majority of Americans will need nursing care, either at home or in a nursing facility, at some point in their lives. 

For most of us, out-of-pocket payment for long-term nursing care is a formidable expense unless provisions have been made in advance.  Unfortunately, at-home full-time care is also out of reach for most families. This is where having a competent, caring elder law attorney who knows the ins and outs of MassHealth comes in.

What Is MassHealth?

Basically, MassHealth is what Medicaid (combined with CHIP, Children’s Health Insurance Program) is called in Massachusetts. MassHealth is a state and federally funded program that pays a substantial amount of healthcare costs for members, including payments for doctor visits, prescription drugs, hospital stays, rehabilitation, and therapeutic services. 

Importantly, MassHealth also pays for long-term healthcare, either at home or in a nursing facility. The catch is that MassHealth is only granted to individuals who have minimal financial assets. This is why almost everyone has to work with an elder law attorney to achieve and maintain eligibility for its benefits.

Where does Medicare come in?

Medicare is a federally funded program that is, with few exceptions for certain permanent disabilities, available only if you are over the age of 65. Medicare covers partial payments for doctor visits and prescriptions, so most people with Medicare obtain supplemental coverage. If you are eligible for both Medicare and MassHealth, however, Medicare will cover most of your prescription drug copays. 

The major point that concerns us here is that Medicare does not pay for long-term nursing care. If you enter a nursing care facility after a 3-day hospital stay, Medicare will provide complete coverage for only 20 days and partial coverage for 80 days more. During those 80 days, you will owe $185.50 per day even with Medicare assistance, making clear why MassHealth coverage is critically important for most people. 

Are there other options besides MassHealth to pay for long-term care?

There are other alternatives, like the following examples, but for many they are unworkable:

  • Having a relative or close friend provide the care is problematic because loved ones usually have other jobs or responsibilities, are not sufficiently trained or licensed, and/or may not be up to the task physically or emotionally
  • Having a loved one in elder daycare may work for some, but only if the patient is able to sleep through the night without needing further care
  • Some families have the financial resources to pay for round-the-clock private nursing care out-of-pocket, but this is fairly rare, especially since you don’t usually know how lengthy long-term care will turn out to be
  • Other families purchase long-term care insurance that will help, though these policies are also quite costly and do not typically cover all of the costs involved

How can Surprenant & Beneski help with long-term care and eligibility for MassHealth?

At Surprenant & Beneski, P.C., our team of elder law attorneys is well-prepared to assist you at any point in your journey toward finding and funding excellent long-term care. 

In addition, we have the knowledge and skill set to assist you in preparing an estate plan that takes long-term care into account at the start or will help you update your financial plan to satisfy eligibility requirements for MassHealth as soon as you consult us. 

It is crucial to know that MassHealth has a 5-year look-back period, meaning the government will scrutinize your financial transactions going back 5 years to make sure that you didn’t divest yourself of assets by giving them away or selling them far below market value in order to meet their low-asset limit. This is why it’s so important to start planning for long-term care as soon as possible.

Contact a Sharp, Compassionate Team of Elder Law Attorneys

Consulting with Surprenant & Beneski can be reassuring as well as practical. Our practice is centered around our clients and we will go out of our way to make certain that you or your loved one are eligible for the benefits of MassHealth so you can be provided with the very best long-term care available.